Device for maintaining alignment of a cannulated shaft over a guide pin

ABSTRACT

An orthopedic driver is provided that includes an elongate tubular body and an indicator assembly. The indicator assembly has a housing that has at least one opening and a visual indicator disposed in the at least one opening. The visual indicator is configured to be coupled with a guide pin such that lateral movement of the elongate tubular body relative to the guide pin causes the visual indicator to move between a flush or recessed configuration within the housing and an extended configuration. In the extended configuration, the visual indicator extends outward of an outer surface of the housing. The flush or recessed configuration corresponds to alignment of the guide pin relative to the elongate tubular body and the extended configuration corresponds to misalignment of the guide pin relative to the elongate tubular body.

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.14/670,065, filed Mar. 26, 2015, which claims the benefit of U.S.Provisional Patent Application Ser. No. 62/018,963, filed on Jun. 30,2014, which is incorporated by reference herein in its entirety for allpurposes. Any and all applications for which a foreign or domesticpriority claim is identified in the Application Data Sheet as filed withthe present application are hereby incorporated by reference under 37C.F.R. § 1.57.

BACKGROUND OF THE INVENTION Field of the Invention

This application relates to apparatuses and methods for maintainingalignment of cannulated shafts over slender guide structures, such asguide pins.

Description of the Related Art

It is conventional in orthopedics to use a drill or other driver toolequipped with a drill bit to modify bone and to deliver implants into abone surface or cavity. A surgeon can use a simple technique to guidethe advancement of the drill bit, such as simply visually confirmingthat the drill bit is advancing in a proper direction relative to thebone surface or cavity. Such simple techniques are adequate for grossalignment of the direction of advance of a drill bit but are inadequatewhere higher precision is desired.

A technique for improving guidance of a drill bit is to first place arigid guide pin into the bone. In this technique, the drill bit has ahollow shaft that is placed over the guide pin. As a result, the innersurface of the shaft and the outer surface of the guide pin interact toreduce the range of directions of advance of the hollow shaft of thedrill bit relative to the central longitudinal axis of the guide pin.While a guide pin can reduce the variability of the direction of advanceof a drill bit relative to the bone, there is still the possibility thatthe shaft of the drill bit can be non-parallel to, or otherwise offsetfrom, the guide pin. Also, the guide pin outside of the bone can be bentat an angle relative to the guide pin inserted in the bone thereby notguiding the drill bit along the originally intended direction of theguide pin. A further technique that can be used to correct for suchmisalignment involves the user re-positioning the drill bit in responseto drag between the drill bit shaft and the guide pin. Greater dragindicates a larger angle between the pin and the drill bit shaft. Thisapproach is user and experience dependent, and thus not very reliable orprecise.

Complex systems exist for determining an angle of advance of a drill bitby sensing position in space. Such systems require electronics andsoftware which increase the complexity and cost of the system and ofprocedures utilizing the systems.

SUMMARY OF THE INVENTION

There is a need for new apparatuses and methods for maintainingalignment between a guide pin and a hollow shaft of a drill bit or othertool for driving an implement or implant. Such apparatuses and methodspreferably provide one or more immediately visible, audible, and/orvibratory indications of such structures being non-parallel or otherwiseoff-set or out of alignment. When using a drill or other driver equippedwith a drill bit over a guide pin it is desirable to have continuous,real-time feedback that is easy to see, hear and/or feel so that arotating shaft can be quickly repositioned relative to the guide pin.Thus, the direction of advance of the drill bit can be maintained on orsubstantially on, e.g., within about a few degrees of, the intended axisof advance. The axis of advance can correspond to the centrallongitudinal axis of the guide pin.

In one embodiment, an orthopedic driver system is provided that includesa guide pin and a tool assembly. The tool assembly includes an elongatetubular body and an indicator assembly. The elongate tubular body has adistal portion, a proximal portion, and a lumen extending therethrough.The indicator assembly is disposed between the proximal portion and thedistal portion of the elongate body. The indicator assembly has ahousing that has a plurality of lateral openings. The indicator assemblyalso has an indicator comprising a plurality of radially extending arms.Each of the plurality of radially extending arms has an outer endslidably disposed in a corresponding lateral opening of the housing. Aninner portion of each of the arms is coupled with an inner portion ofthe indicator. The inner portion of the indicator is configured to bedisposed about and in close contact with a side surface of the guidepin. The indicator is rotatable with the elongate tubular body about theguide pin. The indicator is supported in the housing such that a changein the lateral position of the elongate tubular body relative to theguide pin, e.g., adjacent to the indicator, causes the outer end of atleast one of the radially extending arms of the indicator to move to aposition laterally outward of a lateral surface of the housing.

In one variation of the system, a drill is included. The drill isconfigured to engage and to rotate the proximal portion of the elongatetubular body.

In another embodiment, an orthopedic driver is provided that includes anelongate tubular body and an indicator assembly. The elongate tubularbody has a lumen extending from a distal end to a proximal end. Theindicator assembly is disposed between the proximal end and the distalend of the elongate body. The indicator assembly has a housing that hasat least one opening and a visual indicator disposed in the at least oneopening. The visual indicator is configured to be coupled with a guidepin such that lateral movement of the elongate tubular body relative tothe guide pin causes the visual indicator to move between a flush orrecessed configuration within the housing and an extended configuration.In the extended configuration, the visual indicator extends outward ofan outer surface of the housing. The flush or recessed configurationcorresponds to alignment of the guide pin relative to the elongatetubular body and the extended configuration corresponds to misalignmentof the guide pin relative to the elongate tubular body.

In another embodiment, an orthopedic driver is provided that includes anelongate tubular body and an indicator assembly. The elongate tubularbody has a lumen extending proximally from a distal end thereof. Theindicator assembly is disposed proximally of the distal end of theelongate tubular body. The indicator assembly has housing that has anon-smooth surface disposed about an interior lumen thereof. In theorthopedic driver, direct contact is provided between the non-smoothsurface and a side surface of the guide pin upon misalignment of theguide pin and the elongate body. The direct contact produces at leastone of an audible sound and a vibration during rotation of the elongatetubular body about the guide pin.

In another embodiment, a method is provided in which a distal portion ofa guide pin is placed in a bone. An elongate tubular driver ispositioned over a proximal portion of the guide pin. The elongatetubular driver has a body that has a mechanical alignment indicatordisposed therein. The mechanical alignment indicator is activated uponmisalignment of the elongate tubular driver and guide pin. The elongatetubular driver is repositioned in response to at least one of anextension of the mechanical alignment indicator from a side surface ofthe elongate tubular driver, an emission of an audible sound, and avibration in the elongate tubular driver. The audible sound and thevibration, if present, arise from direct contact between the mechanicalalignment indicator and the guide pin.

Any feature, structure, or step disclosed herein can be replaced with orcombined with any other feature, structure, or step disclosed herein, oromitted. Further, for purposes of summarizing the disclosure, certainaspects, advantages, and features of the inventions have been describedherein. It is to be understood that not necessarily any or all suchadvantages are achieved in accordance with any particular embodiment ofthe inventions disclosed herein. No aspects of this disclosure areessential or indispensable.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects and advantages are described belowwith reference to the drawings, which are intended to illustrate but notto limit the inventions. In the drawings, like reference charactersdenote corresponding features consistently throughout similarembodiments. The following is a brief description of each of thedrawings.

FIG. 1 shows a schematic partial phantom view of an orthopedic driversystem being applied to a bone surface;

FIG. 2 shows a plan view of an orthopedic driver according to oneembodiment;

FIG. 2A is a transverse cross-sectional view illustrating one form of amechanical alignment indicator taken at section plane 2A-2A in FIG. 2;

FIG. 2B is a perspective view of a tissue protector having a sleeve witha circumferential gap;

FIG. 3 is longitudinal cross-sectional view of the orthopedic driver ofFIG. 2 taken at second plane 3-3;

FIG. 4 is a perspective view of a portion of a housing for a mechanicalalignment indicator;

FIG. 4A is a plan view showing a non-smooth surface configured to createan audible sound from and/or vibrations in an orthopedic driver uponcertain degrees of misalignment;

FIG. 5 is a perspective view of another portion of a housing for amechanical alignment indicator;

FIG. 6 is a perspective view of one embodiment of a visual indicator,which is one form of a mechanical alignment indicator;

FIG. 7 is a perspective detail partial phantom view of one embodiment ofan orthopedic driver, showing a mechanical alignment indicator with twomodes of alignment feedback;

FIG. 8A is a top cross-section view of the orthopedic driver of FIG. 7showing a condition of misalignment;

FIG. 8B is a top cross-section view of the orthopedic driver of FIG. 7showing a condition of alignment;

FIG. 9 is a perspective detail partial phantom view of anotherembodiment of an orthopedic driver, showing a visual indicatorindicating a condition of misalignment;

FIG. 10A is a top cross-section view of the orthopedic driver of FIG. 9showing a condition of misalignment;

FIG. 10B is a top cross-section view of the orthopedic driver of FIG. 9showing a condition of alignment;

FIG. 11A is a top cross-section view of another embodiment of anorthopedic driver, showing an auditory or tactile indicator indicating acondition of misalignment in a condition of misalignment; and

FIG. 11B is a top cross-section view of another embodiment of anorthopedic driver, showing an auditory or tactile indicator indicating acondition of misalignment in a condition of alignment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

While the present description sets forth specific details of variousembodiments, it will be appreciated that the description is illustrativeonly and should not be construed in any way as limiting. Furthermore,various applications of such embodiments and modifications thereto,which may occur to those who are skilled in the art, are alsoencompassed by the general concepts described herein. Each and everyfeature described herein, and each and every combination of two or moreof such features, is included within the scope of the present inventionprovided that the features included in such a combination are notmutually inconsistent.

FIG. 1 shows an orthopedic driver system 100 that includes a guide pin104, a tool assembly 108, and a drill 112. In the illustration, a distalportion of the system 100 is disposed in the bone B and a proximalportion is coupled with the drill 112. The bone B can be a portion of ashoulder, for example a portion of a scapula.

The guide pin 104 includes a distal end 124, a proximal end 128, andelongate body 132 extending therebetween. FIG. 1 shows that, in use, thedistal end 124 is disposed in the bone B. The distal end 124 may beinserted into the bone B to a depth sufficient to retain the pin 104 inthe bone B. The proximal end 128 is disposed away from the bone B and isable to receive a cannulated portion of the tool assembly 108. Incertain embodiments, the cannulated portion of the tool assembly 108 islonger than the pin 104 such that the proximal end 128 of the pin 104 isdisposed inside the tool assembly 108 during operation of the system100. The guide pin 104 is sufficiently rigid so that it can serve therole of guiding other portions of the driver system 100. The guide pin104 can be formed of or include a suitable biocompatible metal, such asstainless steel.

FIGS. 2 and 3 show the tool assembly 108 in more detail. The toolassembly 108 can be used as an orthopedic driver to transmit a torquefrom the drill 112 to an implement 144 (discussed further below). Thetool assembly 108 includes an elongate tubular body 148 and an indicatorassembly 152. In one embodiment the indicator assembly 152 is disposedin a middle section of the elongate tubular body 148. The position ofthe indicator assembly 152 and the length of the guide pin 104 are suchthat the proximal end 128 of the guide pin 104 is proximal of theindicator assembly 152 when the implement 144 is at the level of thebone B as shown in FIG. 1. The implement 144 can be coupled with thetool assembly 108 in any suitable manner such as with threads as shownin FIG. 3.

FIG. 3 shows that in the illustrated embodiment, the elongate tubularbody 148 has a distal portion 160, a proximal portion 164, and a lumen168 that extends therethrough. The lumen 168 can have a distal portionthat extends through a distal tubular member 172 and a proximal portionthat extends at least partially through a proximal tubular member 176.The lumen 168 also extends through the indicator assembly 152, e.g.,through a housing 200 thereof as discussed further below.

The drill 112 is configured to engage the proximal portion 164 of theelongate tubular body 148 and thereby to rotate the elongate tubularbody 148. FIG. 3 shows a drive component 180 coupled with a proximal endof the proximal tubular member 176. The drive component 180 can have anysuitable configuration for being engaged by the drill 112. For examplethe drive component can have a plurality of flat surfaces 182 to beengaged by a chuck of the drill 112. In the illustrated embodiment, thedrive component 180 includes a small lumen 184 disposed therethrough.The lumen 184 is configured to be large enough to receive the guide pin104. In various embodiments the elongate tubular body 148 is longer thanthe guide pin 104 such that when the elongate tubular body 148 isdisposed over the guide pin 104 the proximal end 128 of guide pin 104does not extend to or proximally of the drive component 180. The drivecomponent 180 can be coupled with or can form a unitary extension of theproximal end of the proximal tubular member 176. In one embodiment adistal portion of the drive component 180 can be enlarged to have arecess (not shown) large enough to receive a proximal end of theproximal tubular member 176. The distal portion of the drive component180 and the proximal portion of the proximal tubular member 176 can bejoined in any suitable manner. For example, these components can be ofunitary or monolithic construction or can be press fit together, welded,or joined by mechanical fasteners or an adhesive of any suitable type.FIG. 3 shows that the drive component 180 can have a stepped downprofile along its length.

As noted herein, the drill 112 is used to rotate the tubular body 148 tocause the implement 144 to act on the bone or on an implant. If thisprocedure is performed through tissue, e.g., in a minimally invasiveprocedure with small incisions, it may be desirable to protect thetissue from the rotating tubular body 148. In some embodiments aprotector 194 is provided along at least a portion of the elongate body148, e.g., covering at least a portion of the distal tubular member 172.The protector 194 can be in the form of a bushing or other sleeveconfigured to enable relative motion of the portion of the elongate body148 disposed therein, e.g., of the distal tubular member 172. FIG. 2Bsuggests that the sleeve need not completely encircle a spaced thatreceives the distal tubular member 172. Rather, the protector can covera portion of the distal tubular member 172 sufficient to keep the tissueaway from the rotating portions of the elongate tubular body 148. In oneembodiment, the protector 194A has a circumferential gap 195A thatextends along its length. The circumferential gap 195A enables theprotector 174 to be easily assembled onto the distal tubular member 172.In one embodiment, the protector 194A is configured to be flexibleenough to permit the circumferential gap 195A to expand to allow thedistal tubular body 172 to pass through the circumferential gap 195A ofthe protector 174. The protector 194A preferably thereafter elasticallyreturns toward the unexpanded state such that the distal tubular body172 is securely retained in the protector 174. The circumferential gap193A of the protector 194A enables the protector 174 to be removed fromthe distal tubular body 172, e.g., for cleaning. In other embodimentsthe protector 194 is cylindrical. Removal of the protector 194 ispossible for example when the implement 144 is unthreaded and removed.Thereafter the protector 194 can be slid off the distal end of thedistal tubular member 172. The protector 194 includes a plurality ofapertures 195 that are useful for cleaning the protector 174.

In one embodiment, the tool assembly 108 is configured to restrict theaxial movement of the protector 194. For example, a collar 196 can beprovided in some embodiments that has a proximally facing shoulder 198.The proximally facing shoulder 198 preferably has a lateral dimensionmeasured radially away from the outer surface of the distal tubularmember 172 that is large enough to restrict motion of the protector 194.For example the shoulder 198 can have a lateral dimension measuredradially away from the outer surface of the distal tubular member 172that is greater than the thickness of the protector 194. The collar 196and shoulder 198 are proximal extension of the implement 144 in theillustrated embodiment. In other embodiments, the collar is affixed tothe distal tubular member 172 and can be left in place when theimplement 144 is removed. The shoulder 199 limits distal movement of theprotector 194 over the distal tubular member 172. In one embodiment, theprotector 194 is disposed between opposing shoulders. For example, adistally facing shoulder 199 can be provided on a distal end of theindicator assembly 152. The distally facing shoulder 199 preferably hasa lateral dimension measured radially away from the outer surface of thedistal tubular member 172 that is large enough to restrict motion of theprotector 194. For example the shoulder 199 can have a lateral dimensionmeasured radially away from the outer surface of the distal tubularmember 172 that is greater than the thickness of the protector 194.

FIG. 3 shows the indicator assembly 152 being disposed between theproximal portion 164 and the distal portion 160 of the elongate tubularbody 148. FIG. 7 shows that the indicator assembly 152 has a housing 200having a plurality of lateral openings 204. In the illustratedembodiment, there are four openings 204 disposed symmetrically about thehousing 200. The openings 204 can be disposed such that thecircumferential mid-point of one of the openings 204 is 90 degrees apartfrom the circumferential mid-point of one of the openings 204, whenviewed in a plane perpendicular to a longitudinal axis of the toolassembly 108. The lateral openings 204 are defined between a distalportion 212 of the housing 200 and a proximal portion 216 of the housing200. The lateral openings 204 can be defined between a circumferentialgap (discussed below) provided in a side surface of the proximal portion216. In the illustrated embodiment, a proximal end of the proximalportion 216 is configured to receive a distal end of the proximaltubular member 176. In the illustrated embodiment, a distal end of thedistal portion 212 is configured to receive a proximal end of the distaltubular member 172.

FIGS. 4 and 4A show details of the proximal portion 216 of the housing200. The proximal portion 216 includes a proximal body 224 and aplurality of distal posts 228. The distal posts 228 extend distally froma distal end of the proximal body 224. In the illustrated embodiment,the proximal body 224 has a tapered configuration. The taperedconfiguration provides a narrower profile at a proximal end of the body224 and a wider profile at the distal end of the proximal body 224. Eachof the distal posts 228 forms one circumferential edge of one of theopenings 204. A distal end 232 of each of the distal posts 228 isadapted to be received in a corresponding structure of the distalportion 212 of the housing 200. Each of the distal posts 228 forms aportion of a cylindrical lateral surface of the indicator assembly 152.FIG. 4A shows that each of the distal posts 228 can be configured with agenerally triangular cross-section, such as with two side surfaces 244extending from a cylindrical outer surface 248. Two of the distal posts228 in part define one of the openings 204 (shown in FIG. 7). Inparticular, two side surfaces 244 that face each other define a gap 252therebetween. The gap 252 is provided in the lateral surface of theproximal portion 216. The gap 252 is one dimension, e.g., acircumferential dimension, of each of the openings 204. A dimensiontransverse to the gap 252 extends between a distal portion of theproximal body 224 and a proximal portion of the distal portion 212, asdiscussed further below. The gap 252 provides a space in which anindicator (discussed below) can move to indicate an aligned condition orto indicate a misalignment condition. In some embodiments, an indicatorcan slide radially in at least two directions in the gap 252 (e.g., leftand right or up and down in FIG. 4A).

FIGS. 4 and 4A show that in one embodiment a non-smooth surface 256 isprovided in the indicator housing 152. In particular, the non-smoothsurface 256 can be disposed on the distal end of the proximal body 224.The non-smooth surface 256 can take any suitable form, for example caninclude a plurality of scallops, sinusoidal undulations, or otherperiodic or non-periodic deviations from a radius of curvature centeredon a central axis of the lumen 168 when disposed in the tool assembly108. As discussed in greater detail below, interaction between the guidepin 104 and the non-smooth surface 256 can provide a mechanicalalignment indicator for indicating the alignment of the longitudinalaxes of elongate body 148 and the guide pin 104. More particularly,direct contact between the non-smooth surface 256 and the guide pin 104can result in the emission of audible sound from the tool assembly 108upon rotational movement of the non-smooth surface 256 relative to theguide pin 104. Direct contact between the non-smooth surface 256 and theguide pin 104 can result in vibration in the tool assembly 108 uponrotational movement of the non-smooth surface 256 relative to the guidepin 104. Direct contact between the non-smooth surface 256 and the guidepin 104 can result in both the emission of audible sound from the toolassembly 108 and in vibration in the tool assembly 108 upon rotationalmovement of the non-smooth surface 256 to the guide pin 104. The guidepin 104 and the non-smooth surface 256 when interacting to produce anaudible sound provide one means for indicating misalignment. The guidepin 104 and the non-smooth surface 256, when interacting to produce avibration, provide another means for indicating misalignment. The guidepin 104 and the non-smooth surface 256, when interacting to produce avibration and an audible sound, provide another means for indicatingmisalignment.

FIGS. 3 and 5 show additional details of the distal portion 212 of thehousing 200 of the indicator assembly 152. The distal portion 212includes a distal body 268 and a proximal indicator support platform 272coupled with the distal body 268. The proximal indicator supportplatform 272 can be integrally formed with the distal body 268 or can beattached thereto. The proximal indicator support platform 272 extendsproximally of the proximal end of the distal body 268. A plurality ofrecesses 276 is provided, disposed about the indicator support platform272. The recesses 276 are configured to receive the distal support posts228. It is contemplated that various shaped recesses and correspondinglyshaped distal ends are within the scope of this disclosure. Each of therecesses 276 may end in a triangular surface configured to receive oneof the distal ends 232 of the distal posts 228. The illustratedembodiment, recesses 276 extending to four triangular surfaces areprovided. An aperture 280 is provided through the distal body 268 andthrough indicator support platform 272. The aperture 280 is larger thanthe guide pin 104 such that some amount of movement of the guide pinwithin the aperture 280 is permitted. The length of the distal posts 228of the proximal portion 216 and the depth of the recesses 276 extendingfrom the triangular surfaces (or alternatively the height of theindicator support platform 272) are such that the openings 204 havesufficient height to permit an indicator (discussed below) to beslidably disposed between the distal and proximal portions 212, 216 ofthe indicator assembly 152.

FIGS. 1-3 show that the indicator assembly 152 has an indicator 300disposed therein. The indicator 300 can comprise any suitable form forbeing recessed in the housing 200 in one configuration of the toolassembly 108 and being extended therefrom in another configuration ofthe tool assembly 108. In one embodiment, illustrated in FIGS. 6-7, theindicator 300 has a disc structure having a distal face 302A and aproximal face 302B. The indicator 300 can include a plurality ofradially extending arms 304. FIGS. 2 and 2A show that the arms 304 canbe disposed 90 degrees apart when viewed in a plane perpendicular to alongitudinal axis of the tool assembly 108. That is, a centrallongitudinal axis of one of the arms 304 can be disposed 90 degrees fromthe central longitudinal axis of two adjacent arms 304 when viewed in aplane perpendicular to a longitudinal axis of the tool assembly 108.FIGS. 6 and 7 show that each of the plurality of radially extending arms304 has an outer end 308. Each of the outer ends 308 is slidablydisposed in a corresponding lateral opening 204 of the housing 200 inone configuration. In the illustrated embodiment, there are four arms304 and four openings 204. In other embodiments, there can be more thanfour arms 304, e.g., five, six, seven, eight or more arms 304. Inanother embodiment, there can be fewer than four arms 304, e.g., one,two or three arms. FIGS. 11A and 11B illustrate embodiments in which amechanical indication of alignment or misalignment is provided in whichthere are no arms or openings. An inner portion 312 of each of the arms304 is coupled with an inner portion 316 of the indicator 300.

The inner portion 316 of the indicator 300 is configured to be disposedabout, and in close contact with, a side surface of the guide pin 104.The inner portion 316 can include an aperture 320 that is slightlylarger than the outer diameter of the guide pin 104. In one embodiment,the distal face 302A includes a structure to facilitate loading the toolassembly 108 over the guide pin 104. Such structure is useful where theaperture 320 has a diameter that is close in size to the diameter of theguide pin 104. The distal face 302A can include a concave surface 324disposed between the inner portions 312 of the arms 204 and the aperture320. The concave surface 324 can be centered on the aperture 320. Theconcave surface 324 can direct the guide pin 104 through the aperture320. Because the indicator 300 is movable in the housing 200 the concavesurface 324 can also cause the aperture 320 of the indictor to translateto a position closer to the central longitudinal axis of the elongatetubular body LA_(ETB). The concave surface 324 can take any suitableform. For example, the concave surface 324 can be at least partiallyconical in one embodiment.

The indicator 300 is rotatable with the elongate tubular body 148 aboutthe guide pin 104. FIG. 2A shows that the distal posts 228 of theproximal portion 216 of the indicator assembly 152 are in the same planeas the body of the indicator 300. More particularly, a plane disposedtransverse to the longitudinal axis of the tool assembly 108 includes aportion of each of the arms 204 and a portion of each of the posts 228.The posts 228 are rigidly connected to other portions of the elongatebody 148. When the elongate body 148 is rotated by the drill 112, theposts 228 are also rotated. The indicator 300 is movable between theposts 228, but side surfaces of the posts 228 push the indicator 300 inrotation. Thus, rotation of the drill 112 rotates the tool assembly 108including the elongate tubular body 148, the housing 200, and theindicator 300. While the indicator 300 rotates with the distal andproximal portions 212, 216 of the housing 200 relative motion of theindicator and the housing 200 is generally limited to sliding in alateral direction or in a radial direction on the platform 272 andwithin and out of the openings 204.

The indicator 300 is supported in the housing 200 such that a change inthe lateral position of the elongate tubular body 148 relative to theguide pin 104 causes the outer ends 308 of the radially extending arms304 of the indicator 300 to move. FIG. 7 shows that such movement candispose the outer end 308 of one of the arms 304 at a position laterallyor radially outward of a lateral surface of the housing 200. FIG. 7shows that such movement can dispose the outer end 308 of one of thearms 304 at a position laterally or radially outward of the cylindricalouter surfaces 248 of the posts 212.

FIGS. 8A and 10A show that in various embodiments, the visual indicator300 is coupled with the guide pin 104 such that relative lateralmovement of the elongate tubular body relative to the guide pin 104causes the visual indicator 300 to move between a flush or recessedconfiguration within the housing 200 (FIGS. 2A, 8B and 10B) and anextended configuration in which the visual indicator extends outward ofthe housing (FIGS. 7, 8A, 9 and 10A). The flush or recessedconfiguration corresponds to alignment of the guide pin 104 relative tothe elongate tubular body 148 and the extended configuration correspondsto misalignment of the guide pin 104 relative to the elongate tubularbody 148. The indicator 300 thus provides a means for indicatingmisalignment.

FIG. 7 shows that one of the arms 304 has a length sufficient to extendthrough a corresponding opening 204 to a position laterally outward of alateral surface of the housing, e.g., to a position lateral of thecylindrical outer surface 248. The flush configuration of FIG. 2A isprovided in part from the width of the indictor 300 being less than orequal to the diameter of the housing 200. For example, a distanceprovided between the outer ends 308 of two arms disposed 180 degreesapart is less than or equal to the width of the housing 200 adjacent tothe openings 204. In this context, the distance is measured as a lineextending parallel to or in a plane containing the longitudinal axes ofthe arms 304 and the center of the aperture 320. Where the distance isless than the diameter of the housing 200 adjacent to the openings 204,the ends 308 can be recessed in the openings 204. To enable theindicator 300 to be visible, the lateral movement of the indicator 300greater than the distance that the ends 308 are recessed is provided.One approach to providing sufficient lateral movement is to make thelateral dimension of the arms 304 smaller than the width of theopenings, i.e., the gap 252. For example, the dimension of the arms 304perpendicular to the longitudinal axis of the arms can be about ¾ thedimension of the gap 252. To provide more lateral movement, thedimension of the arms 304 perpendicular to the longitudinal axis of thearms can be about ½ the dimension of the gap 252. To provide still morelateral movement, the dimension of the arms 304 perpendicular to thelongitudinal axis of the arms can be about ¼ the dimension of the gap252.

The indicator 300 rotates with the tool assembly 108 in one mode orphase of operation. When one of the ends 308 extends through and out ofan opening 204 and the tool assembly 108 is rotating the protrusion isvisible as an eccentric blur. This blur in rotation corresponds to therelative position of a longitudinal axis LA_(G) and the guide pin andthe longitudinal axis of the elongate tubular body LA_(ETB) as shown inFIG. 8A. The eccentric blur is immediately visible to the user. Becauseit is immediately visible, the user can quickly re-position the toolassembly 108 to reduce, e.g., to minimize, the time that the tool 108 isrotating off-set from the guide pin 104. Keeping the eccentric blur to aminimum or retaining the tool assembly 108 in the recessed configurationis one way to retain the longitudinal axis LA_(G) and the guide pin andthe longitudinal axis of the elongate tubular body LA_(ETB)substantially parallel to, e.g., coincident with, each other as shown inFIG. 8B.

In another mode or phase of operation the indicator 300 can indicatemisalignment when the tool assembly 108 is not rotating. As discussedabove, the guide pin 104 extends through the aperture 320. As thelongitudinal axis LA_(G) and the guide pin and the longitudinal axis ofthe elongate tubular body LA_(ETB) become misaligned one or more of theends 308 emerges from one or more of the openings 204. Thus, even priorto rotation the user can see whether the axes LA_(G), LA_(ETB) aregenerally aligned or may be misaligned. This is an important way toavoid initial errors in the initial direction of advance of theimplement 144 before the tool assembly 108 begins to act on the bone oran implant to be positioned in the bone.

FIGS. 9-10B illustrate an embodiment of an orthopedic driver 400 havingan indicator 300 that provides visual indication of alignment withoutrequiring audible and/or vibratory tactile feedback. The indicator 300is disposed in a housing that has a smooth surface 256A disposed aboutan interior lumen 424. The smooth surface 256A can be disposed on one orboth of proximal and distal portions of a housing 200A. In theillustrated embodiment, the distal end of a proximal body 224A of aproximal portion 216A of the housing 200A includes the smooth surface256A. The indicator 300 provides alignment feedback by displacement ofthe end 308 out of an opening 204 as shown in FIG. 10B and similar tothe embodiment discussed above. As discussed above, the indicator 300rotates with elongate tubular body 148. In an out of alignmentconfiguration the end 308 is displaced out of the housing 200A (whenrotating or when not rotating relative to the guide pin 104). In thisposition the longitudinal axis LA_(G) and the guide pin and thelongitudinal axis of the elongate tubular body LA_(ETB) are off-set. Thesmooth surface 256A may directly contact the guide pin 104 withoutsubstantial audible sound or vibration due to the smoothness of thesurface.

FIGS. 11A and 11B illustrate another embodiment in which an indicatorassembly 506 is provided. The indicator assembly 506 includes amechanical alignment indicator by incorporating the non-smooth surface256 into a proximal housing 216B. The proximal housing 216B forms partof a housing similar to the housing 200 described above. The non-smoothsurface 256 is capable of contacting the guide pin 104 as indicated inFIG. 11A when there is misalignment between the longitudinal axis LA_(G)and the guide pin 104 and the longitudinal axis LA_(ETB) of an elongatetubular body including the proximal housing 216B. Such contact producesone or both of an audible sound or a vibration in the tool assembly inwhich the non-smooth surface 256 is disposed. The sound or vibrationprovides mechanical feedback to the user to reposition the tool assemblyincluding the non-smooth surface 256 (e.g., in the proximal housing216B) relative to the guide pin 104. Such repositioning can cause thelongitudinal axis LA_(G) and the guide pin 104 and the longitudinal axisLA_(ETB) of an elongate tubular body into which the housing 216B isincorporated to be aligned as in FIG. 11B.

FIGS. 1 and 7-11B illustrate various methods in connection with thetools discussed herein. As discussed above, a guide pin 104 can beplaced into the bone B to a depth sufficient to secure the guide pin inthe bone and at a desired alignment angle relative to the bone. The toolassembly 108 is then positioned over the guide pin 104. The elongatetubular body 148 is positioned over a proximal portion of the guide pin104. The elongate tubular body 148 has a mechanical alignment feedbackindicator disposed therein. In the embodiment of FIGS. 9-10B themechanical alignment feedback indicator includes a visible or visualindicator as discussed above. In the embodiment of FIGS. 11A-11B themechanical alignment feedback indicator includes a non-smooth surface256 that provides audible or tactile feedback upon direct contactbetween the non-smooth surface and the guide pin 104. In the embodimentof FIGS. 1-8B, the mechanical alignment feedback indicator includes boththe non-smooth surface 256 and the visible or visual indicator 300 suchthat more feedback can be provided.

In the case of the embodiment of FIGS. 1-7, the indicator 300 isactivated upon misalignment of the elongate tubular body 148 of the toolassembly 108 and the guide pin 104. Such feedback can be provided whenthere is relative rotation between the tool assembly 104 and the guidepin 104 or when there is no such relative rotation. FIG. 8A shows thatthe mechanical alignment indicator is activated by the guide pin 104directly pushing the indicator 300 such that the outer end 308 of one ofthe arms 304 emerge from the openings 204 in the housing 200 and isvisible. As noted above when the ends emerge from the openings 204 andthe tool 108 is rotated, a blur pattern is visible.

FIG. 8A shows that the mechanical alignment indicator is activated bythe guide pin 104 coming into direct contact with the non-smooth surface256. Relative rotation causes periodic contact between the guide pin 104and the non-smooth surface 256. If the non-smooth surface 256 comprisesa plurality of equally spaced scallops the mechanical alignmentindicator may produce a repeating audible sound that is different fromthe sound of the drill or other operating room components. Thisrepeating sound can be a staccato chattering sound. This structure canbe configured to induce a vibration in the tool assembly 108 that isfelt by the user. Thus, vibration is another mechanical alignmentindicator that can provide feedback to the user.

In one method, the user repositions the elongate body 148 of the toolassembly 108 in response to feedback. The repositioning can be duringrelative rotation between the tool assembly 108 and the guide pin 104 orwhen there is no such relative rotation, e.g., before any rotation hastaken place. The feedback can include at least one of an extension of aportion of the visual indicator 300 from a side surface of the housing200. The feedback can include an emission of an audible sound arisingfrom direct contact between the non-smooth surface 256 and the guide pin140. The feedback can include a vibration in the elongate tubular body148 of the tool assembly 108 arising from direct contact between thenon-smooth surface 356 (or other mechanical alignment indicator) and theguide pin 140. The repositioning of the elongate body 148 causes thelongitudinal axis LA_(G) of the guide pin 104 and the longitudinal axisLA_(ETB) of the elongated tubular body 148 to be moved back towardalignment, e.g., with these axis coincident as shown in FIG. 8B.

Various configurations provide feedback to maintain alignment of thetool assembly 108 and the guide pin 104. Alignment includes where thelongitudinal axis LA_(G) of the guide pin 104 and the longitudinal axisLA_(ETB) of the elongated tubular body 148 are perfectly aligned. Invarious embodiments, misalignment triggering feedback can include acondition where the axes LA_(G), LA_(ETB) are at least partially offset,e.g., non-parallel. The axes LA_(G), LA_(ETB) can be offset when theycross at the surface of the bone but are not co-linear at the locationof the housing 200. In some embodiments, feedback is not triggered atsmall offsets of the axes LA_(G), LA_(ETB). For example, a thresholdangle can be provided below which feedback is not provided and abovewhich feedback is provided. In some embodiments, the threshold angle isbetween about 0.5 degrees and about 10 degrees. In other embodiments,the threshold angle is between about 1 degree and about 5 degrees. Inother embodiments, the threshold angle is between about 0.5 degree andabout 4 degrees. In other embodiments, the threshold angle is betweenabout 0.5 degree and about 3 degrees. In other embodiments, thethreshold angle is between about 0.5 degree and about 2 degrees. Inembodiments, threshold angle may vary depending on relationship ofcannula size/diameter to the guide pin size/diameter.

In some embodiments, feedback may be of more than one type and more thanone threshold angle is provided. For example, a first threshold can beprovided in which a lower level of misalignment is provided between theaxes LA_(G), LA_(ETB). A first feedback corresponding to misalignmentexceeding the first threshold offset between the axes LA_(G), LA_(ETB)can include visual feedback provided by the arms 304 emerging from theopenings 204 as discussed above. The first feedback can arise at a lowerlevel of misalignment, e.g., at above about 0.5 degrees. A secondfeedback corresponding to misalignment exceeding a second thresholdoffset between the axes LA_(G), LA_(ETB) can be provided and can includeaudible and/or tactile feedback. The audible and/or tactile feedback canbe provided by direct contact between the guide pin 104 and thenon-smooth surface 256. The second feedback can arise at a higher levelof misalignment, e.g., at above about 1 degree or about above 5 degrees.In various embodiments, the first and second feedback will be presentsimultaneously when the second threshold is exceeded.

The methods illustrated by FIGS. 10A and 10B are similar to those ofFIGS. 8A and 8B. FIG. 10A shows misalignment of the longitudinal axisLA_(G) of the guide pin 104 and the longitudinal axis LA_(ETB) of theelongated tubular body including the proximal housing 216A. Althoughthere may be contact between the guide pin 104 and the smooth surface256A, such contact will not result in noticeable vibration or audiblesound. Rather, the extension of the end 308 of the arm 304 will providevisual feedback to reposition the system to a more aligned state, as inFIG. 10B. Such feedback can be provided when there is relative rotationbetween the tool assembly 108 and the guide pin 104 or when there is nosuch relative rotation.

The methods illustrated by FIGS. 11A and 11B are similar to those ofFIGS. 8A and 8B. FIG. 11A shows misalignment of the longitudinal axisLA_(G) of the guide pin 104 and the longitudinal axis LA_(ETB) of theelongated tubular body including the proximal housing 216B. Contactbetween the guide pin 104 and the non-smooth, e.g., undulated surface256 results in noticeable vibration or audible sound. There need not beany visible change in the appearance of the tool. The vibration or soundprovides mechanical feedback to move the system to a more aligned state,as in FIG. 11B. The apparatuses and method illustrated by FIGS. 11A and11B allow a mechanical indicator to be activated upon relative rotationbetween the tool assembly and the guide pin 104. These apparatuses andmethods can eliminate the openings 204, providing a simpler and/or moreenclosed arrangement.

The foregoing devices and methods can be used to achieve much improvedcontrol of steps of preparing bone in connection with orthopedicprocedures. For example, the implement 144 can include a bone cutting orreaming implement. In some embodiments implement 144 may be comprised ofa drill bit, a reamer, a broach, a rongeur, a rasp, a file, or otherimplements. Such implements can be used to prepare a surface to receivean implant or to cut recesses or channels in bones for other purposes.The implement 144 can be a tool interface configured to be coupled withan implant to enable the tool assembly 108 to drive the implant intobone. Thus, the implement 144 can be an implant driving interface.

Some embodiments have been described in connection with the accompanyingdrawings. However, it should be understood that the figures are notdrawn to scale. Distances, angles, etc. are merely illustrative and donot necessarily bear an exact relationship to actual dimensions andlayout of the devices illustrated. Components can be added, removed,and/or rearranged. Further, the disclosure herein of any particularfeature, aspect, method, property, characteristic, quality, attribute,element, or the like in connection with various embodiments can be usedin all other embodiments set forth herein. Additionally, it will berecognized that any methods described herein may be practiced using anydevice suitable for performing the recited steps.

For purposes of this disclosure, certain aspects, advantages, and novelfeatures are described herein. It is to be understood that notnecessarily all such advantages may be achieved in accordance with anyparticular embodiment. Thus, for example, those skilled in the art willrecognize that the disclosure may be embodied or carried out in a mannerthat achieves one advantage or a group of advantages as taught hereinwithout necessarily achieving other advantages as may be taught orsuggested herein.

Although these inventions have been disclosed in the context of certainpreferred embodiments and examples, it will be understood by thoseskilled in the art that the present inventions extend beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the inventions and obvious modifications and equivalentsthereof. In addition, while several variations of the inventions havebeen shown and described in detail, other modifications, which arewithin the scope of these inventions, will be readily apparent to thoseof skill in the art based upon this disclosure. It is also contemplatedthat various combination or sub-combinations of the specific featuresand aspects of the embodiments may be made and still fall within thescope of the inventions. It should be understood that various featuresand aspects of the disclosed embodiments can be combined with orsubstituted for one another in order to form varying modes of thedisclosed inventions. Further, the actions of the disclosed processesand methods may be modified in any manner, including by reorderingactions and/or inserting additional actions and/or deleting actions.Thus, it is intended that the scope of at least some of the presentinventions herein disclosed should not be limited by the particulardisclosed embodiments described above. The limitations in the claims areto be interpreted broadly based on the language employed in the claimsand not limited to the examples described in the present specificationor during the prosecution of the application, which examples are to beconstrued as non-exclusive.

What is claimed is:
 1. A method comprising; placing a distal portion ofa guide pin in a bone; positioning an elongate tubular driver over aproximal portion of the guide pin, the elongate tubular drivercomprising a body having a mechanical alignment indicator disposedtherein, the mechanical alignment indicator activated upon misalignmentof the elongate tubular driver and guide pin; and repositioning theelongate tubular driver in response to an extension of the mechanicalalignment indicator from a side surface of the elongate tubular driver.2. The method of claim 1, wherein the elongate tubular body is coupledwith a bone cutting implement and further comprising reaming the boneover the guide pin.
 3. The method of claim 2, wherein repositioning theelongate tubular driver occurs during reaming.
 4. The method of claim 2,wherein repositioning the elongate tubular driver occurs when there isno reaming.
 5. The method of claim 1, wherein the elongate tubular bodyis coupled with an implant and further comprising advancing the implantinto the bone over the guide pin.
 6. The method of claim 1, wherein theextension of the mechanical alignment indicator provides a visualindication of misalignment of the guide pin.
 7. The method of claim 1,wherein the mechanical indicator comprises a plurality of radiallyextendable arms.
 8. The method of claim 1, wherein repositioning theelongate tubular driver comprises moving the elongate tubular driverrelative to the guide pin until the mechanical alignment indicator nolonger extends from the side surface of the elongate tubular driver. 9.A method comprising; placing a distal portion of a guide pin in a bone;positioning an elongate tubular driver over a proximal portion of theguide pin, the elongate tubular driver comprising a body having amechanical alignment indicator disposed therein, the mechanicalalignment indicator activated upon misalignment of the elongate tubulardriver and guide pin; and repositioning the elongate tubular driver inresponse to an emission of an audible sound arising from direct contactbetween the mechanical alignment indicator and the guide pin.
 10. Themethod of claim 9, wherein the elongate tubular body is coupled with abone cutting implement and further comprising reaming the bone over theguide pin.
 11. The method of claim 10, wherein repositioning theelongate tubular driver occurs during reaming.
 12. The method of claim10, wherein repositioning the elongate tubular driver occurs when thereis no reaming.
 13. The method of claim 9, wherein the elongate tubularbody is coupled with an implant and further comprising advancing theimplant into the bone over the guide pin.
 14. A method comprising;placing a distal portion of a guide pin in a bone; positioning anelongate tubular driver over a proximal portion of the guide pin, theelongate tubular driver comprising a body having a mechanical alignmentindicator disposed therein, the mechanical alignment indicator activatedupon misalignment of the elongate tubular driver and guide pin; andrepositioning the elongate tubular driver in response to a vibration inthe elongate tubular driver arising from direct contact between themechanical alignment indicator and the guide pin.
 15. The method ofclaim 14, wherein the elongate tubular body is coupled with a bonecutting implement and further comprising reaming the bone over the guidepin.
 16. The method of claim 15, wherein repositioning the elongatetubular driver occurs during reaming.
 17. The method of claim 15,wherein repositioning the elongate tubular driver occurs when there isno reaming.
 18. The method of claim 14, wherein the elongate tubularbody is coupled with an implant and further comprising advancing theimplant into the bone over the guide pin.